Tourniquet Should be very very carefully used in Low Ejection fraction cases. ( Poor myocardial Function) posted for knee replacement surgery. Prolonged Application of Torniquet leads to accumulation of anaerobic metabolites in the lower limb — When the tourniquet is released SUDDENLY, ( It is better if the tourniquet is released gradually ) Anaerobic Metabolites released into circulation — cause profound Vado dilatation, Hypotension, due to Myocardial depression. This effect is seen in almost all patients in a milder degree — But in poor Myocardial Function cases ( Low Ejection fraction EF ) — This effect is exaggerated leading to prolonged profound Hypotension.
Requiring vasopressor support to recover back to normal. Duration of application of Torniquet is also very important — tourniquet time cannot exceed 1 hour in poor Myocardial Function cases. === RELEASE OF TORNIQUET…
